Q. What’s going on with rabies these days? We don’t seem to hear much about it anymore.

A. Unfortunately, rabies is still with us and it is still a deadly disease. The incidence of rabies is very low in the U.S. (only 27 human cases since 1990), but is much more common in undeveloped countries. While not common, rabies gets a high level of attention when there is a case because of the scariness of the disease. Rabies remains incurable; there is no reliable treatment once the disease has progressed. To put it bluntly, once you show symptoms of the disease, you almost certainly die within days. Only two people have survived rabies without receiving the preventive shots.

The good news is that rabies is 100% preventable if the victim receives the vaccine right away, before symptoms develop. Rabies is a viral disease that affects humans and other mammals. The early symptoms are flu-like and similar to that of many other diseases. Symptoms progress to include paralysis, hallucinations, difficulty swallowing, and hydrophobia (fear of water). Pre-symptom treatment still involves a series of shots, but these are not the painful shots in the abdomen that used to be the standard treatment. Between 16,000 and 39,000 people receive preventive medical treatment each year after being exposed to a potentially rabid animal.

Most of the cases each year involve exposure to wild animals such as raccoons, bats, skunks, coyotes, and foxes. Raccoons are the animals most likely to be infected, but bats account for 74% of the human cases since 1990. There are cases where people have been exposed to rabies from domestic cats that apparently caught the disease from wild animals.

Most people understand that you get rabies from the bite of a rabid animal. What most people still don’t know, however, is that you can also get rabies simply from a scratch or contact with the saliva or brain tissue of an infected animal. There doesn’t have to be a bite involved. This is a special concern for children and sometimes for the elderly, ill, or those with cognitive problems who may have been exposed to a rabid animal, but not bitten. If a bat, for example, has been in a room with a child or mentally impaired person, you should assume there has been a bite or contact with saliva and the bat should be tested.

There was a case where school children handled a dead bat in class that was later found to be rabid. Even a dead bat can still transmit rabies through its saliva. All of the children were evaluated for risk. If they had touched the bat’s mouth or had open wounds or skin breaks, or had touched their eyes, mouth, or nose after handling the bat, they were advised to get rabies shots.

If bitten by an animal, immediately wash the bite area with soap and water. It’s important to know whether the animal could be rabid. Dogs and cats are required by law to have rabies shots and you should ask for proof that the animal is up to date on shots. If proof is not available, domestic animals are usually quarantined and observed for a period of time. If bitten by a bat or other wild animal, the animal should be captured and killed for testing. If an animal cannot be caught, you should assume the animal might have rabies and should undergo rabies shots as a preventive measure. You could take your chances but the penalty for being wrong is death! See your physician after any animal bite for treatment and consultation.

We wary of any animal that is acting strangely and warn your children to do the same. This can mean a wild animal that is acting unusually tame, or a tame animal that is acting unusually wild. Keep your distance and call your animal control officials or local health department if you spot a suspicious animal that could be rabid.